and suggested reading
Overall:

1. Gain concentrated skill sets to improve care in family medicine clinic.
2. Learn when you can treat a condition on your own in family medicine clinic and when you need to refer.
3. Gain familiarity with specialty care so you can help support family medicine patients through such care.
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     Dermatology

     1. 1. Describe skin lesions accurately
     2. 2. Perform punch and shave skin biopsies
     3. 3. Accurately select lesions for appropriate destructive therapy
     4. 4. Manage common chronic skin problems such as eczema and psoriasis and acne
     5. 5. Able to recognize potentially malignant skin lesions and select appropriate biopsy technique.
     Suggested reading:
     • Selected Articles from the Skin Conditions AFP Topic Page:
       • § Common Benign Skin Tumors, 2003
       • Pages 325-342 of The Resident’s Guide to Ambulatory Care.
         • Atypical Moles, 2008
         • Clinical Diagnosis of Melanoma (November 2008)
         • Recognizing Neoplastic Skin Lesions- A Photo Guide, 2008
         • Shave and Punch biopsy for Skin Lesions, 2011
         • Dermatologic Conditions in Skin of Color, Part I, Part II (June 2013)
         • Diagnosis and Treatment of Acne (October 2012)
         • Minocycline for Acne Vulgaris (September 2013)
         • Psoriasis (May 2013)
         • Atopic Dermatitis: An Overview (July 2012)

Neurology

1. Demonstrate competence in performance of basic neurological exam
2. Discuss diagnostic and therapeutic approach to headaches
3. Describe the risks and benefits of common seizure medications and review what labs need to be monitored for the various seizure medicines
4. Review basic work up of Multiple Sclerosis
5. Review common movement disorders such as Parkinson’s disease.

• Recommended reading: Pages 206-222 of The Resident’s Guide to Ambulatory Care.

Recommended listening:
Headache Update. Audio Digest Family Practice | Volume 58, Issue 15 | April 21, 2010
Play here (below) or download file

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Radiology

1. Perform basic interpretation of chest x-rays and skeletal films

Minor Procedures

1. 1. Demonstrate competence with simple interrupted skin closure
2. 2. Demonstrate competence with the removal of simple skin lesions
3. 3. Name and utilize common surgical tools for minor outpatient procedures

Suggested reading:

• Fusiform (Elliptical) Excision (AFP April 2003)
• Minimal Excision Technique for Epidermoid (Sebaceous) Cysts (AFP April 2002)
• Pages 333-335 of The Resident’s Guide to Ambulatory Care.

Gastroenterology

1. 1. Discuss diagnostic and therapeutic approach to GERD and peptic ulcer disease
2. 2. Discuss diagnostic and therapeutic approach to hepatitis C
3. 3. Discuss diagnostic and therapeutic approach to irritable bowel syndrome
4. 4. Understand GI tests and what they will and won’t do for you
5. 5. Learn the relevant components of a GI history

Suggested reading:

• Managing Chronic Gastroesophageal Reflux Disease (AFP October 2012)
• Diagnosis and Management of IBS in Adults (AFP September 2012)
• Peptic Ulcer Disease (AFP October 2007)
• Selected Articles from the Dyspepsia and Hepatitis / Liver Disease AFP Topic Pages:
  • o AGA Releases Updated Recommendations on Dyspepsia (July 2006)
  • o Update on the Evaluation and Management of Functional Dyspepsia (March 2011)
  • o Nonalcoholic Fatty Liver Disease: Diagnosis and Management (July 2013)
  • o Hepatitis B: Diagnosis and Treatment (April 2010)
  • o Hepatitis C: Diagnosis and Treatment (June 2010)
  • o Cirrhosis: Diagnosis, Management and Prevention (December 2011)

Pages 222-240 of The Resident’s Guide to Ambulatory Care.

Internal Medicine

1. 1. Discuss diagnostic and therapeutic approach to coronary artery disease
2. 2. Discuss diagnostic and therapeutic approach to congestive heart failure
3. 3. Discuss diagnostic and therapeutic approach to hypertension
4. 4. Discuss diagnostic and therapeutic approach to diabetes
5. 5. Review work-up and management of hypo and hyperthyroidism

Suggested reading:

• Medical Management of Stable Coronary Artery Disease (AFP April 2011)
• Diagnosis and Evaluation of Heart Failure (AFP June 2012)
• 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults (JNC 8) (JAMA February 2014)
• Diabetes Type 2 (AFP April 2014)
• Hypothyroidism: An Update (AFP August 2012)
• Hyperthyroidism: Diagnosis and Treatment (AFP August 2005)
• Pages 146-155, 189-205 of The Resident’s Guide to Ambulatory Care.

Treadmill

1. Competently perform an exercise stress test with stand-by supervision
2. Accurately interpret the results of a stress test
3. Discuss indications for treadmill stress test versus other testing options
4. Improve EKG reading skills

Recommended reading: Pages 121-129, 161-166 of The Resident’s Guide to Ambulatory Care.

Flexible Sigmoidoscopy

1. Competently perform flex sig with stand-by supervision by the end of third year
2. Accurately identify abnormal findings during the flex sig procedure
3. Discuss colon cancer screening in the normal risk vs. high risk patient

Recommended reading: Pages 107-109 of The Resident’s Guide to Ambulatory Care.

Rheumatology

1. Discuss diagnostic and therapeutic approach to rheumatoid arthritis
2. Discuss diagnostic and therapeutic approach to systemic lupus
3. Discuss diagnostic and therapeutic approach to psoriatic arthritis

Recommended reading: Pages 257-273 of The Resident’s Guide to Ambulatory Care.
Recommended listening:
ARTHRITIS
Internal Medicine | Volume 60, Issue 28 | July 28, 2013
http://www.audio-digest.org/pages/htmlos/45328.3.624941541417245348

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Urology

1. Accurately assess the size and texture of the prostate on digital rectal exam
2. Discuss diagnostic and therapeutic approach to urinary incontinence
3. Discuss diagnostic and therapeutic approach to management of kidney stones
4. Discuss diagnostic and therapeutic approach to prostate cancer and benign prostate hypertrophy
5. Learn the work up for hematuria
6. Learn the work up for sexual dysfunction

Recommended reading: Pages 274-284 of The Resident’s Guide to Ambulatory Care.

ENT

1. Discuss diagnostic and therapeutic approach to recurrent otitis media
2. Discuss diagnostic and therapeutic approach to chronic hoarseness
3. Discuss diagnostic and therapeutic approach to chronic cough
4. Discuss diagnostic and therapeutic approach to chronic sinusitis

Recommended reading: Pages 28-33, 250-256 of The Resident’s Guide to Ambulatory Care.

Ophthalmology

1. Learn to read an ophthalmology clinic note
2. Learn how to accurately assess ocular pressure with hand held pressure gauge
3. Observe a basic diabetic retinal exam
4. Review differential diagnosis of the red eye
5. Review ophthalmologic emergencies

Recommended reading: Pages 246-249 of The Resident’s Guide to Ambulatory Care.

Pain and Wellness Clinic

1. Become familiar with group visit model
2. Observe psychologist interaction with group with regard to chronic pain management

Recommended reading: Pages 359-361 of The Resident’s Guide to Ambulatory Care.

Positive Health Clinic

1. Describe the current guidelines as to when to start antiviral therapy
2. Describe current guidelines regarding when to start and stop opportunistic infection prophylaxis
3. Describe two preferred regimens for initial antiviral therapy
4. Describe an initial workup for a newly diagnosed HIV positive patient
5. Able to recognize thrush and differentiate it from hairy leukoplakia

Recommended reading:
-Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents:
http://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv-guidelines/0

Recommended listening:
HUMAN IMMUNODEFICIENCY VIRUS/HEPATITIS C
Internal Medicine | Volume 60, Issue 24 | June 28, 2013
http://www.audio-digest.org/pages/htmlos/45328.10.745781236617245348

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Surgery

1. Recognize normal and problematic healing of post-op wounds
2. Learn pre-op assessment to determine if surgery will be beneficial
3. Learn the pre-operative work-up of breast masses, thyroid nodules, and gall bladder disease
4. Review diabetic wound care

Recommended reading: Pages 347-358 of The Resident’s Guide to Ambulatory Care.

Breast Health Clinic

1. Show competence in performing a clinical breast exam
2. Show competence in performing a core biopsy of a breast lump and fine needle aspirations of breast cysts
3. Discuss diagnostic and therapeutic approach to managing breast lumps
4. Understand mammogram and ultrasound reports and learn some basic concepts of reading mammograms

Recommended reading: Pages 98-99 of The Resident’s Guide to Ambulatory Care.

Hematology-Oncology

1. 1. Discuss post treatment management of common malignancies (e.g. breast cancer, lung cancer, colon cancer, prostate cancer)
2. 2. Discuss the common side effects of common chemotherapeutic agents and radiation therapy
3. 3. Discuss presentation of common malignancies

Suggested reading:

• Selected Articles from the Cancer AFP Topic Page:
  • o Managing the Adverse Effects of Radiation Therapy (August 2010)
  • o Primary Care of the Patient with Cancer (April 2007)
  • Pages 243-245, 107-109 of The Resident’s Guide to Ambulatory Care.

Chronic Renal Disease

1. 1. Discuss work-up and differential for chronic kidney disease including diabetic and hypertensive renal disease
2. 2. Discuss indications for ace inhibitors
3. 3. Discuss the utility of ultrasound in the context of chronic renal disease

Suggested reading:

• Selected articles from the AFP topic page on Kidney Disease:
  • o Update on the Management of Chronic Kidney Disease (October 2012)
  • o Screening for Chronic Kidney Disease (February 2014)
  • o Urinalysis: A Comprehensive Review (March 2005)
  • Pages 280-282 of The Resident’s Guide to Ambulatory Care.

Pulmonary Clinic

1. Show competence in basic interpretation of chest x-rays and CT scans
2. Discuss diagnostic and therapeutic approach to severe persistent asthma
3. Discuss diagnostic and therapeutic approach to interstitial lung disease/bronchiectasis
4. Discuss management of obstructive lung disease, and discuss when to order O2, steroids, antibiotics, pulmonary rehab

Recommended reading: Pages 167-188 of The Resident’s Guide to Ambulatory Care.

Musculoskeletal Clinic

1. Discuss diagnostic and therapeutic approach to non-operative musculoskeletal injuries
2. Learn basic joint injection techniques
3. Learn preventive treatment for overuse injuries

Recommended reading: Pages 299-324 of The Resident’s Guide to Ambulatory Care.

High Risk Preoperative Clinic

1. 1. Learn how to accurately assess a patient’s surgical risk
2. 2. Discuss indications for cardiac and sleep apnea testing in the preoperative setting
3. 3. Learn to take and document an appropriate preoperative history and physical
4. 4. Learn the importance of functional capacity in the preoperative assessment

Suggested reading:

• ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery
• Preoperative Testing Before Noncardiac Surgery: Guidelines and Recommendations (AFP March 2013)
• Pages 362-370 of The Resident’s Guide to Ambulatory Care.

Allergy clinic

1. Learn when to order allergy testing
2. Review when allergy injections are appropriate
3. Review basic treatment of allergic conditions

Recommended reading: Pages 250-253 of The Resident’s Guide to Ambulatory Care.

Cardiology

1. Discuss diagnostic and therapeutic approach to coronary artery disease
2. Discuss diagnostic and therapeutic approach to congestive heart failure
3. Discuss indications for placement of pacemakers and implantable cardioverter defibrillators (AICDs)
4. Review indications for cardiac catheterization

Recommended reading: Pages 121-129, 146-162 of The Resident’s Guide to Ambulatory Care.

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This page has been edited 2 times. The last modification was made by - jcc240 on Jun 19, 2014 5:25 pm

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This page has been edited 2 times. The last modification was made by - jcc240 on Jun 19, 2014 5:25 pm